Catheter to cannulate the coronary sinus

Abstract

A double catheter includes an outer, resilient catheter having shape memory and a hook-shaped distal end, an inner, pliable catheter slidably disposed in the outer catheter and of greater length than the outer catheter so that a distal end portion of the inner catheter can be extended or retracted from a distal end opening of the outer catheter to vary the overall length of the double catheter, the inner catheter preferably having an internal lumen suitable for the introduction of contrast media, and a mechanism operable from the proximal end of the outer catheter for changing the curvature of the hook shaped distal end of the outer catheter. Such a catheter of the invention can cannulate the coronary sinus without significant manipulation.

What is claimed is:  
     
       1. A double catheter, comprising: 
       an outer, resilient catheter having shape memory and a hook shaped distal end configured for cannulation of the coronary sinus with at least one curved bend;  
       an inner, pliable catheter slidably disposed in the outer catheter and of greater length than the outer catheter so that a distal end portion of the inner catheter can be extended or retracted from a distal end opening of the outer catheter to vary the overall length of the double catheter, the inner catheter having an internal lumen configured for the introduction of contrast media and a pacing lead into the coronary sinus; and  
       a mechanism operable from the proximal end of the outer catheter for changing the curvature of the distal end of the outer catheter.  
     
     
       2. The double catheter of  claim 1 , wherein the mechanism for changing the curvature of the hook shaped distal end further comprises an obturator slidably disposed inside of the inner catheter, wherein the obturator is configured to reduce the curvature of the hook shaped distal end when inserted in the inner catheter. 
     
     
       3. The double catheter of  claim 1 , further comprising a balloon mounted on the outside of the distal end of the outer catheter positioned for occlusion of the proximal coronary sinus, and a conduit permitting inflation of the balloon at the proximal end of the outer catheter. 
     
     
       4. A double catheter, comprising: 
       an outer, resilient catheter having shape memory and a hook-shaped distal end with at least one curved bend;  
       an inner, pliable catheter slidably disposed in the outer catheter and of greater length than the outer catheter so that a distal end portion of the inner catheter can be extended or retracted from a distal end opening of the outer catheter to vary the overall length of the double catheter, the inner catheter having an internal lumen suitable for the introduction of a fluid therethrough; and  
       a mechanism operable from the proximal end of the outer catheter for changing the curvature of the distal end of the outer catheter, wherein the mechanism for changing the curvature of the hook shaped distal end comprises a cable anchored to the outer catheter at a point proximate the distal end of the outer catheter and at a point proximate the proximal end of the outer catheter, whereby shortening of the cable from the point proximate the proximal end of the outer catheter results in increased curvature of the hook shaped distal end.  
     
     
       5. The double catheter of  claim 4 , wherein the cable runs inside a wall of the outer catheter. 
     
     
       6. The double catheter of  claim 1 , further comprising a mechanism operable from a proximal end of the outer catheter for securing the inner catheter against sliding movement relative to the outer catheter. 
     
     
       7. The double catheter of  claim 6 , further comprising a port for introducing a fluid into a space between the inner and outer catheters. 
     
     
       8. The double catheter of  claim 1 , wherein the hook-shaped distal end comprises substantially straight segments spanning three bends. 
     
     
       9. The double catheter of  claim 8 , wherein a first bend adjoining a straight, proximal portion of the outer catheter is in the range of 130° to 175°, a second, intermediate bend is in the range of 75° to 100°, and a third bend nearest the distal end of the outer catheter is in the range of to 130° to 175°. 
     
     
       10. The double catheter of  claim 1 , wherein the mechanism for changing the curvature of the hook shaped distal end comprises a portion of the inner catheter configured to reduce the curvature of the hook shaped distal end when inserted in the outer catheter. 
     
     
       11. A method for placing an electrical lead in a lateral branch of a coronary sinus vein using a double catheter including an outer catheter and an inner catheter slidably disposed inside the outer catheter, comprising: 
       inserting the catheter into the coronary sinus;  
       advancing a guide wire through the catheter into a coronary sinus lateral branch vein;  
       advancing the inner catheter out of a front end opening of the outer catheter along the guide wire into the branch vein;  
       inserting the lead through the outer and inner catheters to a target location in the branch vein; and  
       withdrawing the catheter leaving the lead in the branch vein.  
     
     
       12. The method of  claim 11 , further comprising: 
       adjusting the curvature of the double catheter in order to enter the coronary sinus.  
     
     
       13. An outer catheter configured for use with an inner, pliable catheter which can be slidably disposed in the outer catheter and of greater length than the outer catheter so that a distal end portion of the inner catheter can be extended or retracted from a distal end opening of the outer catheter, the outer catheter comprising a resilient tube having shape memory and sufficient stiffness to permit advancement of the outer catheter into a distal coronary sinus, and having a hook-shaped distal end wherein a first bend adjoining a straight, proximal portion of the outer catheter is in the range of 130° to 180°, a second, intermediate bend is in the range of 75° to 100° in a direction opposite the first bend, and a third bend nearest the distal end of the outer catheter in the same direction as the second bend is in the range of to 130° to 175°. 
     
     
       14. The catheter of  claim 13 , wherein the first bend equals 180°, rendering the outer catheter substantially J-shaped. 
     
     
       15. The catheter of  claim 13 , wherein the first bend is in the range of 130-175°, rendering the outer catheter substantially question mark-shaped. 
     
     
       16. The catheter of  claim 13 , wherein the outer catheter is made of a braided silastic. 
     
     
       17. The catheter of  claim 13 , wherein the outer catheter further comprises: 
       an external inflatable cuff near the distal end of the outer catheter; and  
       means for inflation of the cuff sufficient to permit occlusion of the proximal coronary sinus.  
     
     
       18. A double catheter, comprising: 
       an outer catheter comprising a resilient tube having shape memory and sufficient stiffness to permit advancement of the outer catheter into a distal coronary sinus, and having a hook-shaped distal end wherein a first bend adjoining a straight, proximal portion of the outer catheter is in the range of 130° to 180°, a second, intermediate bend is in the range of 75° to 100° in a direction opposite the first bend, and a third bend nearest the distal end of the outer catheter in the same direction as the second bend is in the range of to 130° to 175°, and  
       an inner, pliable catheter slidably disposed in the outer catheter and of greater length than the outer catheter so that a distal end portion of the inner catheter can be extended or retracted from a distal end opening of the outer catheter to vary the overall length of the double catheter, wherein the inner catheter has an internal lumen suitable for the introduction of a fluid therethrough and a hemostatic valve at a proximal end thereof that prevents leakage of blood when a pacing lead is introduced through the inner catheter into the coronary system.  
     
     
       19. The double catheter of  claim 18 , wherein the first bend equals 180°, rendering the outer catheter substantially J-shaped. 
     
     
       20. The double catheter of  claim 18 , wherein the first bend is in the range of 130-175°, rendering the outer catheter substantially question mark-shaped. 
     
     
       21. The double catheter of  claim 18 , wherein the outer catheter is made of a braided silastic. 
     
     
       22. The double catheter of  claim 18 , wherein the outer catheter further comprises: 
       an external inflatable cuff near the distal end of the outer catheter; and  
       means for inflation of the cuff sufficient to permit occlusion of the proximal coronary sinus.  
     
     
       23. The double catheter of  claim 18 , further comprising a mechanism operable from a proximal end of the outer catheter for changing the curvature of the distal end of the outer catheter. 
     
     
       24. A method for placing a electrical lead in a lateral branch of a coronary sinus vein using a double catheter including an outer catheter comprising a resilient tube having shape memory and sufficient stiffness to permit advancement of the outer catheter into a distal coronary sinus, and having a hook-shaped distal end, and an inner, pliable catheter slidably disposed in the outer catheter and of greater length than the outer catheter so that a distal end portion of the inner catheter can be extended or retracted from a distal end opening of the outer catheter to vary the overall length of the double catheter, the method comprising: 
       inserting the catheter into the coronary sinus;  
       advancing a guide wire through the catheter into a coronary sinus lateral branch vein;  
       advancing the inner catheter out of a front end opening of the outer catheter along the guide wire into the branch vein;  
       inserting the lead through the outer and inner catheters to a target location in the branch vein; and  
       withdrawing the catheter leaving the lead in the branch vein.  
     
     
       25. The method of  claim 24 , wherein a first bend adjoining a straight, proximal portion of the outer catheter is in the range of 130° to 180°, a second, intermediate bend is in the range of 75° to 100° in a direction opposite the first bend, and a third bend nearest the distal end of the outer catheter in the same direction as the second bend is in the range of to 130° to 175°. 
     
     
       26. The method of  claim 25 , wherein the first bend equals 180°, rendering the outer catheter substantially J-shaped. 
     
     
       27. The method of  claim 25 , wherein the first bend is in the range of 130-175°, rendering the outer catheter substantially question mark-shaped.